perinatal health and history
Either the locks were too large, or the key was too small, but at any rate it would not open any of them. Alice's Adventures in Wonderland
In my last year of school, second wave feminism reached Australian shores. Despite her pleas, my mother had been forced to leave school at the end of Year 10, but my parents expected my sisters and I to have careers like any boy.
By the late 1980s, I’d qualified as a doctor, done a spell in Indigenous health, and opened my own little practice, where, in keeping with the times, some women liked to take the speculum out of my hand and self-insert for pap smears. Breastfeeding rates had picked up from the nadir of the 60s and early 70s, in large part due to the breastfeeding activism of Nursing Mothers of Australia.
When my daughter Emma was born in 1990, she was kept separate from me in a nursery at the Royal Brisbane Women’s Hospital, but by the turn of the century, large central nurseries were disappearing. Because it’s now known that separation in the sensitive first hours and days disrupts breastfeeding and bonding, most babies today receive skin-to-skin contact immediately after birth, and room in with their mothers.
Birth itself, though, remains profoundly medicalised and technologised: one in three women giving birth in Australia will have a caesarean section, and about one in three will have epidurals. Midwives have little time on the wards to meet the needs of each new mother, who is usually sent home within a day or two of the birth. Breastfeeding rates, if anything, have again declined in recent years.
Medicalisation of mother–baby care is one of Homo sapiens most brilliant adaptations, protecting child-bearing women and their babies from the intimate horror of biological dissolution. But as doctors hurried to save our lives, infant care lost its moorings, and the social behaviours that support the neurohormonal synchrony between a mother and baby have been profoundly disrupted.
Technologised birth (with its accompanying medications and possible mother–baby separation in the first hours afterwards) affects the baby’s primitive neurological reflexes, and the mother’s milk supply, which directly interfere with feeding. Feeding is intimately related to the baby’s biological drives for sensory nourishment and sleep. Yet as a result of our history, health professionals are not yet adequately trained in the prevention, identification and repair of clinical problems that may arise in these areas between mothers and babies.
Worse, many are trained to promote rules about how to read and respond to baby’s communications, which families are supposed to apply if they want the best for their child (and who doesn’t want the best for their child?) but which make unsettled behaviour worse. In other words, health professionals are not only inadequately trained to help remove clinical obstacles to mother–baby synchrony but are told to give advice and rules which interfere with the single most important mechanism that makes families adaptable and resilient, the capacity to be flexible and to experiment in communications with their unique baby.
As a result, life after birth is seriously out of sync for many families in the West. Like Alice, the keys they are given won’t open any doors in the long, dark hall. Being ‘out of sync’ means that being with the baby doesn’t feel particularly pleasant a lot of the time. Maybe the baby won’t settle at the breast or bottle, fretting and fussing and back-arching when his mother tries to feed him. Maybe he wakes very frequently day and night, grizzles for hours, or screams. Parents find it hard to know what the baby needs and nothing seems to help. The nights are long and nightmarish. They feel ill with exhaustion. Worst of all, a mother often begins to experience herself as incompetent – she feels disempowered, she blames herself, she despairs. That most get through all of this without ill effects in the end is a testimony to the remarkable resilience of families!
We are at the tail-end of a century-long revolution in mother–baby care. This one final important matter of supporting the neurohormonal synchrony of mothers and babies requires attention before we can say, in the West, that our brilliant transformation of child-bearing is complete.
10 November 2015. Adapted from 'Appendix 1: An Intimate History of Mother-Baby Care in the English-speaking World,' The Discontented Little Baby Book, UQP: 2014;pp. 208-221.
Me and my firstborn 1990
References
Carroll L, Alice’s Adventures in Wonderland, first published Macmillan and Co., London 1866; Books of Wonder, William Morrow & Co., Inc. New York 1992.
Douglas P, ‘Milkmother memoir’, in J Dymond, N Wiley (eds), Motherhood memoirs: mothers creating/writing lives. Demeter Press, Bradford, ON: 2013;pp. 105-130.
Douglas P, ‘Yummy Mummy and the Medicalised Milkmother’, Hecate, 2010;26:119-135.
Thorley V, ‘Initiating breastfeeding in postwar Queensland’, Breastfeeding Review, 2001;9:21-6.
